Kelnor's guide to Advanced Medical

[Kelnor]

Foreword:

This is an advanced guide, focusing mostly on tips and tricks. It assumes you know the basics of medical first and you're probably a medmain that's put way too much time into this system (like I have) already.

Focus:

Stabilize a patient first and foremost. To do this, make sure their heart, lungs and blood volume are good. This is always your first goal, liver, kidneys, fractures can wait. Get BO up and keep it up. Then deal with everything else when you have free bandwidth.

On Scans:

For the rest of this guide, I am going to assume body scanners don't exist, but first some words on when to scan if you do have them.

1. You do not need to scan to stabilize a patient. You have all the tools needed with just a stethoscope and a hand scanner and not even that if you're god tier.
2. Scanning a patient takes time, time they can't be hooked up to an IV or on an OR table. If you know what's killing them, there is no point in scanning. Stabilize them first
3. FR's love to bring you flatlines right after you shove someone in a scanner. You will panic and forget to eject the patient before running over. It will happen eventually. Scanners do not have any warning systems and other doctors will likely not check the scanner. Non stable patients are better left on a bed with a vitals monitor or on a stasis bed in the ICU. Other doctors will check on them, and vitals monitors will warn you if they're BA/BO crashes.
4. The Zeng Hu is great, but it forces you to stand there and do nothing for a long time for the scan. It's best used if you have extra hands, that said, there is no reason not to run around and scan everyone with it if you have nothing better to do. This is also a great way to bully interns by SCREAMING AT THEM TO SCAN. You can also stand in the center of the GTR and scan all four GTR beds simultaneously. Just queue up the scans and don't move or switch hands.
5. The one downside to delaying scans is it can leave someone sitting on a GTR bed getting an IV or waiting for an organ regenerative to do it's job; when they could be getting bone repaired during this time. If they're stabileish and you're not overwhelmed get a scan and get them into an OR. But if you're swamped or the ORs are busy anyway, you probably have bigger patients to worry about.
6. Finally, if you're stumped, SCAN. Scans are the only way to spot appendicitis for example.

Bleeds:

External:

Blood Volume is the biggest killer stop bleeds first, If someone has an external bleed and you don't have a hand scanner you can shift click examine them.

If they have clothing over the affected limb you'll get this message in red.

"Blood running down their neck": Head

"Blood running down their sleeves": One of the Arms or Hands

"Blood running down their thighs": Chest or Groin

"Blood pooling at their feet": One of the legs or feet.

If they don't have clothing covering it, I'm pretty sure it just tells you, but I've not seen it personally.

If you don't have bandages, you can apply pressure by establishing a passive grab, then help intent clicking on them with the location targeted. This can also tell you if they have a bleed there since you will not apply pressure if they do not. They can also do this to themselves by simply help intent clicking themselves while targeting the correct limb (no grab needed.)

Arterials:

The only ABs that really matter are Head, Chest and groin. Arm, leg and feet ABs are really only a problem if they're BV is already low (since it slows how fast you can restore their blood.) or if they have alot of limb bleeds.

Scans are the only way to know where an AB is but; You can guess where an AB is by looking at how fast their BO or BV drops. If it's not dropping at all, it's probably an extremity AB.

ABs generally only form on limbs that have taken damage, if you've bandaged their wounds, try to remember what limbs were damaged, this is where the AB could be.

If you didn't bandage their wounds or forgot where they were, you can strip them and inspect, you'll see "Bandaged tiny/large bruise" notifications.

You can also just ask the patient.

See the scanless surgery section for dealing with ABs without scans.

Applying a splint to a limb with an AB will reduce the AB's severity.

Obviously, give Coaguzol.

Inspecting:

You can inspect injured patients by establishing a passive grab, then help intent clicking limbs.

You can spam this if you're in a hurry, but it might make reading the results difficult.

It will tell you if the limb has open wounds, broken bones or an infection.

It might tell you if they have bandaged wounds without needing to strip them, but I'm honestly not sure.

Scanless Surgery:

You do not need scans to do surgery.

Step one is to fully strip the patient, you will get no info from examining a clothed patient.

Once a patient is opened up, you can examine them and see organ damage and necrosis.

Minor organ damage usually does not show up when examining, but it also rarely causes a serious issue. You can always just use the ATK but be careful about scarring.

For broken bones, use the Inspection method above.

For ABs, open the patient's limb (You do not need to saw bone,) and attempt to apply the fix-o-vein, if there is a bleed, you will start to close it if not you'll get a message about having nothing to do. Prioritize Head->Chest->Groin unless you otherwise know where the bleed may be.

You also might get a blood spurt if you make an incision on a limb with an AB. Just something to keep that in mind.

 

BO, BV Organ Damage and You:

Kelnor, I hear you say. How do you know what's wrong with someone without scanning.

Well, it's simple, git gud.

First, the stethoscope. It will tell you if they have a damaged heart or lung, but it has some caveats.

1. Plate Carriers and Void/Hardsuits reduce it's usefulness. Strip those.
2. If the patient is not breathing, you cannot tell if their lungs are damaged (this affects breath analyzers too by the way)
3. If you get no breathing, get them on EPP then try again.

Lungs:

If they're mechanical; you'll get "damaged fans" if it's damaged. You will "air flowing" if it's not.

If they're organic, you'll get wheezing or gurgling if damaged.

Strained or labored means they're having trouble breathing, probably were recently choking or suffocating.

shallow and rapid means they're in pain.

Whistling means someone poked them with a syringe.

Heart:

If mechanical, you'll get info about a pump. If damaged, it'll be sputtering, otherwise a steady whirl.

If organic, you'll get irregular pulse for damaged. You'll get normal/fast/slow etc pulse if undamaged. Also worth noting if you hear extremally fast and faint, it means they're about to cardiac arrest. Your medhud shows this normally so it's less useful.

It is worth noting that minor damage is not detectable by the stethoscope.

How BO works:

BO is the result of three main factors. How well the heart and lungs are working, pulse and how much blood the patient has.

If the heart or lungs are healthy, and pulse is normal, BO will exactly match Blood Volume.

If the heart or lungs are damaged or the lungs are not breathing, BO will drop down below BV.

EPP can compensate for non breathing lungs and to a lesser extent lung damage.

If pulse drops below normal, BO will drop below BV, if pulse raises above normal, BO will increase above BV.

All of these affects stack, so high pulse with heart damage might cancel out and BO will be around BV for example.

Giving Adrenaline and/or slapping them using pulled punches, will raise pulse and thus BO. This really is only useful in cases of blood loss, and generally has no real purpose and can cause cardiac arrest. It also has no additional affect if their pulse is already high.

Since <30 BO is the real danger zone and you don't get that low in a situation where raising pulse will help. The main use is you might be able to avoid needing brain surgery/alkysine/cryo tube if you can prevent BA from dropping below 69(nice) percent, which this can do but it's extremely niche.

BP:

Blood pressure follows heart health, BV and pulse. So a high BP and low BO almost certainly means lung issues, and a low BP means low BV, heart health or pulse.

You can use this to diagnose between organ damage or low BV based on BP and BO and pulse. You can even sometimes tell if it's heart or lungs using BP (I'm not good enough to do that quickly yet though.)

It's also worth noting that full Blood Volume with EPP on a patient having a cardiac arrest, under CPR or harness should be 30% BO. And should stabilize around 30ish BA and never die.

I believe CPR and harness stack, so can compensate for some blood loss... maybe. Heart damage might affect CPR/Harness BO? But I am not sure so don't quote me on that.

Hand Analyzer:

Tells you Pulse, BP, BO and will warn you if BV is under 70% (SEVERE BLOODLOSS DETECTED in big red letters) It gives you everything you need to know to diagnose heart/lung/blood loss issues.

Vitals Monitors:

The easiest way to confirm BV and thus rule out BV as the cause of the low BO. Also has a nifty warning scream for BA and BO if you forgot about a patient for too long, though don't rely on it since it's usually very late.

 

HELP THEY'RE IN CARDIAC ARREST DUE TO BRAIN DAMAGE AND I CAN'T ATK A BRIAN:

There is one hail mary available to you here.

Get their BV to 100.

Get a harness and EPP on them.

Jam in dex (preferably plus,) every organ regen you got, and all the adrenaline you can (don't go over 10u unless you have adipemcina in.)

Start an Alkysine drip. Stop pneumalin unless they're lungs are still damaged.

CHEST COMPRESS AS HARD AS YOU CAN

SCREAM AS MUCH AS POSSIBLE.

Pray.

Whenever their heart restarts, you get one tick where they'll have a normalish BO. If spikes over 85, that one tick will heal the brain slightly.

Keep doing this until their brain recovers enough to restart autonomic functions.

This rarely works, brain surgery is the better option, but this does avoid brain scarring.

Conclusion:

There ya go. Post questions or corrections please. And keep saving lives.. especially antags and don't forget to let them escape out through maintenance after the surgery while Sec watches helplessly outside the ORs!

Edited July 13, 2023 by Kelnor